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The American people should be grateful to Max Baucus for his courage and hard work, but his greatest accomplishment may be simply to have laid bare the key issues that the House bills have obscured by pretending they won't cost anyone but the rich a penny. Here are a four big ones:

1. Should the federal government be allowed to require anyone to spend as much as 10 percent of their income on anything?

2. Any service in which over 70 percent of households require a subsidy (as all current reform bills assume) has a provider pricing and product problem, not so much an insurer problem.

3. Any insurance purchase mandate is going to cost small businesses and/or taxpayers big money, since Congress seems to have decided that someone else besides the individual beneficiary is going to pay for it. Inevitably, some small businesses will fail or fail to be created because of it, and fewer workers will be hired. Is that a reasonable price? It might be.

4. Consumer reforms (e.g., coverage of pre-existing conditions, protections against dropped coverage or egregious disallowance) and market reforms (e.g., interstate purchasing and more lenient minimum benefits mandates) should be less controversial than coverage expansion and how to pay for it, but reactions to the Baucus bill show they are not. Republicans who oppose consumer reforms and Democrats who oppose market reforms -- including those, like Professor Reich, who do so because it's the "public option or bust" -- deserve equal scorn.

Judging from the diversity of reactions, the complexity of even Baucus's comparatively centrist approach, and the intransigence of all sides, you have to wonder whether it might be better to approach health care reform on a state-level basis -- with federal consumer regulation, program guidelines, state financial incentives and tax policy doing the heavy lifting -- than to try to tackle such a monstrous problem from the federal level.

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